Kidney Week

Abstract: SA-OR114

Sex Differences in Vascular Access

Session Information

• Women's Health and Kidney Diseases
  November 09, 2019 | Location: 145, Walter E. Washington Convention Center
  Abstract Time: 05:42 PM - 05:54 PM

Category: Women’s Health and Kidney Diseases

• 2000 Women’s Health and Kidney Diseases

Authors

• MacRae, Jennifer M., University of Calgary, Calgary, Alberta, Canada

Jennifer M. MacRae, MD, MS

JM MacRae MSc MD FRCPC Dr MacRae is an Associate Professor at the University of Calgary, Cumming School of Medicine with a cross appointment with the Department of Cardiac Sciences. Her clinical and research interests revolve around improving the care of hemodialysis patients.

• Ahmed, Sofia B., University of Calgary, Calgary, Alberta, Canada

Sofia B. Ahmed,

• Elliott, Meghan J., University of Calgary, Calgary, Alberta, Canada

Meghan J. Elliott,

• Quinn, Robert R., University of Calgary, Calgary, Alberta, Canada

Robert R. Quinn,

• James, Matthew T., University of Calgary, Calgary, Alberta, Canada

Matthew T. James,

• Hiremath, Swapnil, University of Ottawa, Ottawa, Ontario, Canada

Swapnil Hiremath,

• King--Shier, Kathryn M., University of Calgary, Calgary, Alberta, Canada

Kathryn M. King--Shier,

• Oliver, Matthew J., Sunnybrook Health Sciences Center, Toronto, Ontario, Canada

Matthew J. Oliver,

• Hemmelgarn, Brenda, University of Calgary, Calgary, Alberta, Canada

Brenda Hemmelgarn,

• Scott-Douglas, Nairne William, University of Calgary, Calgary, Alberta, Canada

Nairne William Scott-Douglas,

• Ravani, Pietro, University of Calgary, Calgary, Alberta, Canada

Pietro Ravani,

Background

Although fistulas are actively promoted, studies report fewer women receive and use a fistula. Whether women undergo similar efforts at fistula creation and procedures as men is unknown. We sought to describe differences between men and women for probability of receiving a fistula attempt, achieving independent fistula use, remaining catheter-free over time, and the rate of access-related procedures as a function of sex in a cohort of Canadian incident hemodialysis patients.

Methods

Prospectively collected vascular access data on incident dialysis patients from five Canadian programs using Dialysis Measurement Analysis and Reporting (DMAR) system to determine differences in fistula related outcomes between women and men. Probability of receiving a fistula attempt and the probability of successful fistula use was determined using binary logistic regression. Catheter and fistula procedure rates were described using Poisson regression. We studied time to fistula attempt and time to fistula use accounting for competing risks of death, transplant and recovery of kidney function.

Results

We included 1,446 (61%) men and 929 (39%) women. Men had a lower body mass index (p<0.001) and were more likely to have coronary artery disease (p<0.001) and peripheral vascular disease (p<0.001) than women. 688 (48%) men and 403 (43%) women received a fistula attempt. After accounting for confounders (age, diabetes, cardiovascular disease, inpatient starts), men were more likely to receive a fistula attempt (OR 1.29 [1.08-1.54] and to achieve catheter free use of the fistula at one year (OR 2.62 [1.88-3.65]. We found an average of 2.30 procedures per person-year after start of dialysis, with no significant difference between men and women (IRR 1.04 [0.93-1.15]). Following a fistula attempt, women received more procedures (IRR men v women: 0.86 [0.77-0.96]) attributed to an increased number of catheter procedures (IRR men vs women: 0.67 [0.56-0.79]. Men received more fistula procedures IRR 1.20 [1.04-1.37]).

Conclusion

We found that, as compared to men, fewer women undergo a fistula attempt and after adjusting for comorbidities this disparity increases. Not only do women have fewer fistula creations, but they are less likely to successfully use their fistula without a catheter in place.